Organization
GENESIS AND LIGHT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALBERT WILSON (EXECUTIVE DIRECTOR)
(601) 362-6736
Entity
Organization
Contact information
Practice address
4914 N STATE ST, JACKSON, MS 39206-4046
(601) 362-6736
(601) 362-6737
Mailing address
4914 N STATE ST, JACKSON, MS 39206-4046
(601) 362-6736
(601) 362-6737
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
25C4PAS-5598
MS
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2014
Last updated
03/17/2023
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